10633 EVERGREEN WAY 2020-05-18 - Laserfiche WebLink

PUBLIC WORKS PERMITAPPLICATION CITY OF EVERETT PERMIT SERVICES Not - 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits 'PROJECT ADDRESS: SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY COMMERCIAL El INDUSTRIAL IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) IF APPLICABLE: 0 FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB*: JOB# ## may!,' +Y *-14, 14_ 0410, FILL IN ALL QUANTITIES OF WORK BELO AS APPLICABLE: ❑FENCE IN ROW FT IN HEI 'T ❑DRIVEWAY APRON/CURB CUT FT WI P U ASPHALT J CONCRETE PAVING SF ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY \ F ❑RETAINING WALL 1 ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑CLEARING/GRADING/FILL/EXCAVATE CY 0 CUT/BORE IN PAVEMENT(PARALLEL) LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF ❑POLE WORK/AERIAL/OVERLASH LF ADDITIONAL DESCRIPTION(AS NEEDED): /- ►o v& /, )( 3o /55� • i- f N 1'A RM>A►TI N. OWNER/APPLICANT NAME: LFL ' Lj co, / 734-4 L1D 2 D f 640 A2 ' M 1 c?C OWNER!APP. MAILING ADDRESS: s -EET ,v )C 31 CITY CL (L Ll EArice_ STATE 4 ZIP /p t 2 f)5 OWNER!APP.PHONE: OWNER/APP.EMAIL: CONTRACTOR NAME: g fAd 0- ) �7 _CONTRACTOR ADDRESS: 4. 01 STREET t C L i� f yAL/i -l^> 2l 1E "-ry STATE G1/4- 2c4 CONTRACTOR PHONE: 426 -345"5565 CONTRACTOR EMAIL: P fit/}IJ 9J . t Ct-oc4.0i— CONTRACTOR LICENSE :(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER /APPLICANT 0 CONTRACTOR , OTHER(Architect,Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 336,0-9.41 347 774"`7LO2 9 4AJ ARM/ ?S CONTACT EMAIL: TpyLo,2 of 516 'IZCH AI Hod.Ce ACKNOWLEDGEMENT..I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT it / J1l� PW Owner/Aut orized Agent Signature Date (Revised 1/52017)